Gatekeeping In Healthcare Systems Case Study

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Gatekeeping within Healthcare Systems

A healthcare system can be defined as a series of interactions between an individual and a professional care-giver under circumstances involving health (Gilles, 2003). The healthcare system is then often divided into three sectors; primary, secondary, and tertiary care (Bodenheimer and Grumbach, 2009). Primary healthcare involves the treatment and prevention of common health problems in a community based setting. Secondary care focuses on the healthcare problems requiring more specialized treatment, such as surgery, in a clinical setting. Tertiary care is focused on the treatment of rare or complex disorders and surgeries. (Bodenheimer and Grumbach, 2009). The way in which a patient moves between these
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In most cases, the first point of contact a patient has with the healthcare system will be a GP or triage nurse. In order for a patient to access more specialized care, they need a referral from the GP to a specialized physician, often based in a hospital or clinical setting (Bodenheimer and Grumbach, 2009). A specialized physician, or secondary care professional, can then further refer the patient to the tertiary care sector if their health problem is highly specialized and requires a complex level of care. Once a patient has undergone secondary or tertiary care, they are often referred back to the primary care specialist for follow-up treatments and prescriptions. Communication is created between primary and secondary sectors under a gatekept system. (Bodenheimer and Grumbach, …show more content…
(Roberts, 2008). There can be several barriers to both access types under a gatekeeping system, including finances and personal barriers such as culture or language (Jatrana and Crampton, 2009). The gatekept healthcare system in New Zealand is publicly financed, with subsidisation of approximately 60% of primary healthcare costs (Jatrana and Crampton, 2009). General practice (GP) services charge fee-for-service, and can set their own rates for the medical centre (Cumming, 2014). The publicly funded parts of the healthcare system focus on preventative and primary care. Additionally, in New Zealand extra financial aid is provided to Public Health Organizations for those in at-risk groups that are unable to afford primary care (Mossialos, Wenzl, Osborn, and Sarnak, 2016).
In the United States, access to healthcare is primarily for those who can afford it via insurance (Bodenheimer and Grumbach, 2009). Healthcare in a non-gatekept country is a luxury, not a universally available subsidised

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